Perception of newly graduated physicians toward ethical education in medical schools: a Brazilian cross-sectional nationwide study

SUMMARY OBJECTIVE: The objective of this study was to evaluate fresh medical graduates' perceptions regarding the general aspects of ethics teaching in Brazilian medical schools. METHODS: A structured questionnaire was applied to 4,601 participants among the 16,323 physicians who registered in one of the 27 Regional Medical Councils of Brazil in 2015. Answers to four questions regarding general aspects of ethics education in medical school were analyzed. Sampling procedures involved two stratification variables: legal nature (public vs. private) of medical schools and monthly household income higher than 10 minimum wages. RESULTS: A large percentage of the participants had witnessed unethical behaviors during contact with patients (62.0%), toward coworkers (51.5%), and in relationships with patients' families (34.4%) over the course of their medical training. Even though most of the responders (72.0%) totally agreed that patient-physician relationship and humanities education were part of their medical school curriculum, important topics such as conflicts of interest and end-of-life education were not satisfactorily addressed in the participants' medical training. Statistically significant differences were found between the answers of public and private school graduates. CONCLUSION: Despite great efforts to improve medical ethics education, our findings suggest the persistence of deficits and inadequacies in the ethics training currently given in medical schools in Brazil. Further modifications in ethics training must be made to address the deficiencies shown in this study. This process should be accompanied by continuous evaluation.

Perfil Multicêntrico do Acadêmico de Medicina e suas Perspectivas sobre o Ensino da Oftalmologia / Multicentric Medical Student Profile and Their Perspectives About Ophthalmology Education

Resumo Objetivo: Analisar qualitativa e quantitativamente o perfil do aluno de Medicina que cursou a disciplina de Oftalmologia, correlacionando aspectos do seu ensino em conhecimentos básicos e perspectivas discente sobre a sua formação. Métodos: Foi realizado um estudo transversal descritivo do tipo inquérito, em 242 alunos de 12 estados brasileiros. A execução do projeto foi feita com a participação das Ligas Acadêmicas de Oftalmologia de Instituições de Ensino Superior vinculadas a Associação Brasileira de Ligas Acadêmicas de Oftalmologia (ABLAO). A amostra foi composta por alunos da graduação do curso de Medicina, escolhidos aleatoriamente, que já cursaram uma disciplina referente a Oftalmologia. Foi utilizado um questionário individual com perguntas sobre o perfil do aluno, conhecimentos básicos da especialidade e perspectivas sobre o seu ensino. A análise estatística foi feita com o programa Statistical Package for the Social Sciences SPSS, de forma descritiva, com média, desvio padrão e intervalo de confiança de 95%. Resultados: A média de idade foi de 23,96 (3,36±) anos de idade, e o sexo feminino foi predominante em 63,6%. Participaram 42% dos estados de todas as regiões do Brasil nessa pesquisa. 71,9% dos alunos eram de instituições privadas de ensino e estavam cursando o 8 ° período (±1,97). 43 % faziam parte de Liga Acadêmica de Oftalmologia. Observou-se variação de acertos nas questões de conhecimentos básicos, e ao final 95,9% dos alunos responderam que consideram a Oftalmologia importante na sua formação como médico geral, entretanto apenas 31% se sentem seguros em atender e ou encaminhar pacientes para avaliação do especialista. Conclusão: Definimos nessa pesquisa um perfil para o aluno de graduação que cursou a Disciplina de Oftalmologia. Verificamos o quanto ele considera importante a saúde ocular, e que existe uma procura por mais conhecimento no seu preparo como médico generalista. Constatamos também que as Ligas Acadêmicas de Medicina compõem o principal apoio extracurricular ao seu aprendizado. Consideramos importante que diferentes estratégias de ensino sejam discutidas e implementadas para melhora na sua formação.

Abstract Purpose: To analyze quantitative and qualitative data about the profile of the Medical student who attended the Ophthalmology discipline, correlating aspects of the basic knowledge and the student perspectives on his training. Methods: An observational cross-sectional survey study was performed in 242 students over 12 brazilian states. The project was done by Associação Brasileira de Ligas Acadêmicas de Oftalmologia (ABLAO) with the participation of the associated Academic Leagues of Ophthalmology. The sample was composed by random undergraduate medical students, who have already had Ophthalmology as subject. An individual questionnaire was used with questions about the student profile, basic knowledge of the speciality and perspectives about their teaching. Descriptive statistical analysis was performed with the Statistical Package for Social Sciences SPSS program, measuring mean, standard deviation and 95% confidence intervals. Results: The mean age was 23.96 (3.36±) years and female students were predominant in 63.6%. 42% of the states from all regions of Brazil participated. 71.9% of the students were from private educational institutions and were in the 8th period (±1,97). 43% were a member of the Academic League of Ophthalmology in the origin institution. Basic knowledge questions had a variation of the correct answers. Despite of only 31% of the students feel safe to attend or refer patients for evaluation of the specialist, 95.9% of the students answered that they consider ophthalmology important in their training as general practitioner. Conclusion: We defined in this research a profile for the undergraduate student who attended the Ophthalmology Department. We verify how the student considers eye health important and how they search for more knowledge in his preparation in general. We also found that the Medical Academic Leagues make up the main extracurricular support for their learning. It is important to discuss and implement different teaching strategies to improve their training.

Who and Where are the University of São Paulo Medical School Graduates?

OBJECTIVE: To evaluate the impact of a complex-care-based medical school in the context of the Brazilian health care system on students' career choices. METHODS: This was a retrospective cross-sectional study based on medical regulatory organization records. It included records for 7,419 physicians who graduated from FMUSP. Geographic data were analyzed using Kernel maps, and the statistical analysis was performed with SPSS® version 24.0. A p-value less than 0.05 was considered significant. RESULTS: Of the 7,419 physicians, 68.6% (95% CI 67.5-69.7) were male, and 20.7% (95% CI 19.8%-21.7%) had no medical specialty, compared to 46.4% nationwide. Internal medicine and surgery-based specialties were more popular, accounting for 39.4% (95% CI 38.3%-40.5%) and 16.8% (95% CI 15.5%-17.6%) of our study group, compared to the Brazilian averages of 25.9% and 13.5%. Our graduates also had a higher probability of staying in São Paulo City, especially when born outside the city. CONCLUSION: We believe that FMUSP remains an interesting model for studying the impact of a highly specialized center on the education and career choices of medical students.

Why ophthalmology? Analysis of the motivating factors influencing the choice of ophthalmology as a career among different generations in Brazil

OBJECTIVES: The increasing demand for medical specialties with flexible working hours has been associated with the important role of quality of life as a determining factor when choosing a career in medicine, which might change the motivations for pursuing a career in ophthalmology. We aim to identify the main determinants of ophthalmology as a career choice as well as the reasons that motivated previous generations to follow this path. METHODS: Responses to self-administered online questionnaires were analyzed. RESULTS: A total of 225 responses were analyzed, including those of baby boomers (21), generation X (48), generation Y (131) and generation Z (25). Although the main reasons for choosing ophthalmology as a career are the same for all the generations in this study (flexible working hours, self-satisfaction from helping people improve their vision and the possibility of performing surgical procedures), some reasons for this career choice are more important to the younger generations (short-term results and short procedures), and some are more important to the older generations (the influence of an ophthalmologist in the family). CONCLUSION: The main reasons for choosing ophthalmology as a career are essentially the same over time. The differences in secondary motivations could be explained by generational differences.

Precision Medicine: Changing the way we think about healthcare

Health care has changed since the decline in mortality caused by infectious diseases as well as chronic and non-contagious diseases, with a direct impact on the cost of public health and individual health care. We must now transition from traditional reactive medicine based on symptoms, diagnosis and treatment to a system that targets the disease before it occurs and, if it cannot be avoided, treats the disease in a personalized manner. Precision Medicine is that new way of thinking about medicine. In this paper, we performed a thorough review of the literature to present an updated review on the subject, discussing the impact of the use of genetics and genomics in the care process as well as medical education, clinical research and ethical issues. The Precision Medicine model is expanded upon in this article to include its principles of prediction, prevention, personalization and participation. Finally, we discuss Precision Medicine in various specialty fields and how it has been implemented in developing countries and its effects on public health and medical education.

Palhaços: uma revisão acerca do uso dessa máscara no ambiente hospitalar / Payasos: una revisión sobre el uso de esa máscara en el ambiente hospitalario / Clowns: a review about using this mask in the hospital environment

Grupos de artistas profissionais ou voluntários têm-se formado com o intuito de visitar, como palhaços, pacientes em hospitais ao redor do mundo, fazendo uso do humor como ferramenta a favor do cuidado e do processo de recuperação. Há poucos estudos relacionados ao tema na literatura científica. Assim, a construção de um campo teórico capaz de subsidiar essas atuações ainda é incipiente. Realizamos, portanto, uma revisão bibliográfica, a partir de 33 artigos, sobre a atuação de diferentes grupos de palhaços em vários hospitais do mundo, a fim de compreender melhor como se dão estas visitas e de que modo podem efetivamente trazer resultados positivos. Foi observado que estes encontros podem estabelecer relações profundas capazes de ressignificar o ambiente hospitalar, empoderar os pacientes e servir como modelo de relação para toda a equipe de saúde envolvida...

Se han formado grupos de artistas profesionales o voluntarios con el objetivo de visitar, como payasos, pacientes en hospitales del mundo entero, utilizando el humor como herramienta en favor del cuidado y del proceso de recuperación. Hay pocos estudios relacionados a ese tema en la literatura científica. Por lo tanto, la construcción de un campo teórico capaz de subsidiar esas actuaciones todavía es incipiente. Siendo así, realizamos una revisión bibliográfica a partir de 33 artículos sobre la actuación de diferentes grupos de payasos en diversos hospitales del mundo, para entender mejor cómo se realizan esas visitas y de qué modo pueden efectivamente brindar resultados positivos. Se observó que esos encuentros pueden establecer relaciones profundas capaces de dar un nuevo significado al ambiente hospitalario, de dar poder a los pacientes y de servir como modelo de relación para todo el equipo de salud involucrado...

Groups of voluntary or professional artists have been formed in order to visit patients in hospitals around the world, as clowns, using humor as a tool to promote the care and recovery process. There are few studies on this topic in the scientific literature. Thus, construction of a theoretical field that is able to support this activity is only just beginning. Therefore, we conducted a bibliographic review based on 33 papers about different clown groups acting in different hospitals worldwide, in order to better comprehend how these visits take place and how they can effectively achieve good results. It was observed that these encounters can establish deep relationships that are capable of creating new meanings for the hospital environment, empowering patients and serving as a relationship model for all the healthcare staff involved...

The role of stress and life events in the onset of depression in the elderly / O papel do estresse e de acontecimentos cotidianos no desenvolvimento da depressão na terceira idade

The prevalence of major depressive episode in the elderly leads to impairment on several aspects of daily life, including life quality, morbid - mortality and increases rates of suicide risks. Stress and life events are frequent triggers of depressive episode in elderly. The present review aimed to explore the aspects related to the onset of depression in old age, focusing on psychosocial and stress. In order to achieve that, we systematically reviewed papers published in the Medline database from 2003-2013. From this study, we verify that depression in the elderly is a complex disorder, more often associated to psychosocial aspects and chronic stress than to genetic and biomarkers. Loneliness, daily and chronic stress, lack of social support, mourning and economical aspects such as retirement and job loss are major risk factors for depression. Generally, negative life events were noticed to cause poorer mental health in advanced age and cumulative stressful events or traumas untreated too. Furthermore, cognitive functions may be affected negatively by lifelong chronic stressors. These events can cause quite a few different impacts in distinct cultures and lifestyles. The consequences also depend on the duration, or on the life period that these episodes occur. The treatment of depression in the elderly should target both medication and psychotherapy in order to account for psychological aspects, especially treatments based on life review. These perspectives are important due to the possibility of development of specific target strategies in order to prevent those risk factors and improve quality of life in elderly. Many points were contradictorily related, overdue the papers had noticed different conclusions about the same studied points. Face of this, we grouped relevant articles with the same results. Notwithstanding, there were points that require more studies, considering the relevance of the theme.

A prevalência de episódios de depressão em idosos leva a prejuízos em vários aspectos da vida diária, incluindo qualidade de vida, morbimortalidade e, também aumento da taxa de suicídio. O estresse e eventos cotidiano são, frequentemente, gatilhos para a depressão que se afloram na idade avançada. A revisão que se segue objetivou explorar os aspectos relacionados ao início da depressão na terceira idade, com foco psicossocial e no estresse. Para tanto, nós sistematicamente revisamos artigos publicados na base de dados Medline (2003-2013). A partir disso, verificou-se que a depressão nos idosos é um distúrbio complexo que está associado mais prevalentemente a aspectos psicossociais e ao estresse crônico do que a características genéticas e biomarcadores. Solidão, estresse diário e crônico ao longo da vida, falta de apoio social, luto e aspectos econômicos, tais como aposentadoria e perda de emprego, são os principais riscos para se desenvolver sintomas depressivos. Ademais, acontecimentos considerados negativos, eventos estressantes que se acumularam ou traumas não tratados durante a vida foram relacionados à piora da saúde mental na idade avançada. Tais eventos podem causar diferentes impactos em culturas e estilos de vida distintos. As consequências também dependem da duração ou do período da vida em que os episódios ocorreram. O tratamento da depressão no idoso deve ser baseado em medicações e psicoterapia, a fim de tratar aspectos psicológicos. Nesse sentido, destaca-se a terapia com base na revisão e análise de vida. Estas perspectivas de tratamento são importantes devido a possibilidade de desenvolver estratégias alvo específicas, a fim de prevenir esses fatores de risco e melhorar a qualidade de vida do idoso. Muitos pontos foram contraditoriamente relacionados, ou seja, artigos que estudaram os mesmos fatores divergiram nas conclusões. Diante disso, nós agrupamos os artigos mais relevantes com convergência de conclusões.